첨포를 이용한 좌주관상동맥 협착증의 치료

윤치순,유경종,이교준,김대준,강면식 대한흉부심장혈관외과학회 1998 Journal of Chest Surgery (J Chest Surg) Vol.31 No.7

좌주관상동맥 협착증은 관상동맥 협착증 환자의 약 7%에서 발생될 정도로 관상동맥 협착증 중에서는 드문 질환이며, 특히 좌주관상동맥 협착증이 독립적으로 나타나는 경우는 1% 미만으로 매우 드물다. 그러나 독립된 좌주관상동맥 협착증이 있는 경우에 보편적인 관상동맥 우회로조성술로는 완전한 재관류를 기대할 수 없다. 따라서 이를 극복하기 위해 좌주관상동맥 혈관성형술이 새로이 시도되고 있다. 연세대학교 심장혈관센터에서는 1994년 5월부터 1996년 2월까지 독립된 좌주관상동맥 협착증을 가진 11명에게 혈관성형술을 시행하여 얻은 결과를 평가하고자 한다. 대상환자의 연령은 34세에서 62세 사이로 평균 44.1 $\pm$ 9.3세였다. 이중 남자가 3명, 여자가 8명 (73%)으로 대부분이 여자였다. 수술전 관상동맥 협착증의 위험요소는 당뇨가 1례, 고혈압이 3례, 흡연이 2례, 과체중이 3례 및 가족력이 1례 있었다. 평균 콜레스테롤 치는 196.5 $\pm$ 33.6 mg/dL였으며, 이중 4례에서 200 mg/dL가 넘었다. 수술전 흉통의 정도는 Class II가 6명, Class III가 5명이었으며, 심전도상에서 T inversion이나, ST elevation이 있으면서 심초음파검사에서 좌심실 운동장애를 보인 예가 4례 있었으나 심근경색증을 보인 예는 없었다. 수술전 좌심실 박출계수는 61.1 $\pm$ 5.9%였다. 수술후 좌심실 박출계수는 65.2 $\pm$ 9.1이었고, 좌심실 운동장애를 보인 예는 없었다. 진단은 좌주관상동맥 입구의 협착증이 8명, 근위부 협착이 3명이었으며, 협착정도는 전례에서 60% 이상이었고 이중 5례는 80% 이상이었다. 수술시 접근방법은 모든 예에서 좌주관상동맥의 전방접근을 시도하였으며, 혈관성형술에 사용한 첨포는 소심낭 (bovine pericardium) 을 사용하였다. 동반수술은 전례에서 좌전하행지에 우회로조성술을 시행하였다 (10례 : 좌내유동맥, 1례 : 대복재정맥). 수술시 측정한 협착부위의 직경은 1례가 1 mm, 나머지 10례는 2 mm였으며, 혈관성형술 후에 측정한 직경은 9례가 4 mm, 2례가 5 mm 였다. 수술후 합병증은 하지의 창상감염이 1례 있었으며, 수술사망은 없었다. 추적조사는 100%가 가능하였으며, 추적조사 기간은 평균 15.5$\pm$5.8 개월이었다. 이 기간 중 흉통이 발생한 예는 없었으며, 심전도상 이상소견을 보인 예도 없었다. 수술후 평균 14.4$\pm$3.3 개월에 관상동맥 조영술을 5례에서 시행하였으며, 5례 모두 좌주관상동맥 혈관성형술 부위는 광범위한 개통이 있었으나, 좌전하행지에 이식한 이식편 중 2례에서 중등도의 협착이 있었으며, 나머지 3례도 혈류량이 상당히 줄어든 소견을 보였다. 이상과 같은 결과로 미루어 독립된 좌주관상동맥 협착증이 있는 경우에 비적응증이 되지 않는다면 혈관성형술이 완전한 재관류를 위하여 이상적인 방법으로 생각되며, 단지 좌전하행지에 시행하는 우회로술은 의미가 없을 것으로 생각된다. The conventional surgical treatment of isolated critical stenosis of the left main coronary artery restores a less physiologic perfusion of the myocardium, leads to occlusion of the left coronary ostium, and consumes an appreciable length of bypass material. From June 1994 to February 1996, eleven patients, three male and eight female, underwent patch angioplasty and additional bypass graft to left anterior descending artery (10 internal mammary artery, 1 saphenous vein) in isolated critical left main coronary artery stenosis. Their ages ranged from 34 to 62 years, mean 44 years. All had 60% to 90% stenosis of the left main coronary artery and Class III angina. The angiogram showed nine osteal lesion and three main stem stenosis. The operation was performed with conventional cardiopulmonary bypass and cold blood cardioplegia. We approached anteriorly and used bovine pericardium as onlay patch in all patients. There were one leg wound dehiscence, but no operative deaths and infarctions. All patients are free of symptoms after a mean follow-up of 15.5 months. Angiographic restudy at an average 14.4 months was obtained in five patients and showed widely patent left main coronary artery with excellent runoff. But additional graft to left anterior descending coronary artery were stenosed in two patients and showed diminutive flow in others. Our preliminary results suggest that angioplasty of the left main coronary artery can be carried out with low operative risks. But additional bypass graft to left anterior descending coronary artery may be unnecessary. The technique appears to be a promising alternative to conventional coronary artery bypass grafting in isolated left main coronary artery stenosis.

영양상태를 평가하기에 적합한 신장 체중형 체격지수

윤치순,정규철,Yoon, Chi-Soon,Chung, Kyou-Chull 대한예방의학회 1979 Journal of Preventive Medicine and Public Health Vol.12 No.1

This study was conducted to find out the most suitable weight-height index out of the $weight/height^{p}-type$ indices that could be used for the evaluation of nutritional status in an epidemiological survey and for the screening of the obesity. The subjects were chosen randomly, 2,182 males and 719 females from college students and office workers in Seoul districts. The 'best' power-type weight-height index for Korean men and women of all ages from 16 to 59 was found to be $weight/height^{1.54}$ for males and $weight/height^{1.42}$ for females. $Weight/height^2$ (Kaup index), however, was the best suited weight-height index for each age group of both sexes except that relative weight (weight/height) was considered to be desirable to apply for males of teen-aged and of over fifties and for females of over forties of age. Normal ranges of Kaup index values for males and females of each age group were presented in tables 5 and 6. These findings suggest that Koreans are generally leaner than other ethnic groups of the same sex and age.

大腿骨幹骨折의 經皮 骨髓腔內 金屬釘 固定術

金學賢,崔昌郁,尹致淳 順川鄕病院 1976 順天鄕醫報 Vol.1 No.2

In spite of some criticism, in 1940, Kuntscher described the technique of closed I-M nailing in human, this method is widely accepted since it contains more adva-ntages in many respects. It prevents loss of hematoma which is important source of callus formation, prevents damage to the periosteum and soft tissues around the fracture and risk of infection is markedly reduced and stable union of the fragments without additional superfluous external fixation which can lead to early functional use of extremity. Closed I-M nailing for femoral shaft fracture were first tried in Soon Chun Hyang Gen. Hospital from June, 1974 34 cases had been performed to Sept., 1976. Our method is adopted from Kuntscher's method mostly and the principle of proceeding the pre-determined nail without reaming of medullary canal, even in proximal fragment in favorab1e circumstance was adopted from Bohler's suggestion, We by experiences with this series, may summarize as follows : 1. 34 adult femoral shaft fractures were treated with Kuntscher's closed I-M aniline between June,'74-Sept.,'76. 2. Approximate males to females ratio are 4 : 1. The youngest age is 17 years and oldest 58 years. 3. Pre-operative distraction of the fracture site was not necessary in most of our cases and the selection of the entrancing point of nail is probably important. 4. There was not a case of non-union or infection. 5. The advantages are the operation is simple, infection rate nil, early rehabili tation and short hospitalization. 6. In conclusion, closed I-M nailing is the method of choice when internal fixation is indicated and most recent fractures of the femoral shaft are best treated by this method.

자궁경부암의 자궁방결합조직 침습에 관한 위양성 CT 소견

윤치순 대한영상의학회 1994 대한영상의학회지 Vol.30 No.2

목 적: CT에서 자궁경부암의 자궁방결합조직 침습의 위양성 소견을 분석하고 그 원인 인자를 찾아 보았다. 대상 및 방법: CT상 자궁방결합조직 침습의 위양성 소견을 보인 14명 환자의 17개의 자궁방결합조직을 대상으로 하여, 그 CT 소견을 후향적으로 분석하여 조직학적 소견과 비교하였다. 결 과: CT에서 자궁방결합조직 침습의 위향성 소견의 원인으로는 두드러진 기저인대(12예), vaginal fomix(3예), 두드러진 자궁혈관 음영(3예) 이였다. 결 론: 위양성 소견의 원인 인자를 이해함으로서 CT상 자궁경부암에의한 자궁방결합조직 침습 유무의 정확도를 높일 수있을 것이다. Purpose To evaluate the causative factors of the false positive CT findings of parametrial invasions of cervial cancer.Materials and Methods: we analysed 17 parametria of 14 patients with the diseases staged over llb on CT, but confirmed to be under stage lla on pathology. The CT findings were retrospectively reviewed, and compared with pathologic findings.Results : The causes of false postive diagnosis of parametrial invasions on CT were prominent cardinal ligaments (n=12), vaginal fornix(n=3), and prominent uterine vessels(n=2).Conclusion : Familiarity with these CT finding may be helpful in avoiding false positive diagnosis of parametrial invasion In patients with uterine cervical carcinoma.

남자 대학생의 최대 유산소 작업능의 평가

윤치순,정규철 중앙대학교 의과대학 의과학연구소 1983 中央醫大誌 Vol.8 No.2

This study is designed to obtain date for the assessment of maximal aerobic work capacity of young male adult. College students were as subjects, and heart rate, oxygen uptake and energy cost were measured on 75 volunteers during treadmill walking at speed of 2, 4, 6 and 8km/hr with different grade of inclination from level (0%) to 25%. Individual maximal oxygen uptake was predicted using Astrand and Ryhming's nomogram from the data obtained during the treadmill walking, and compared with the measured value on 28 subjects plotting on the linear regression of heart rate on oxygen uptake. The results obtained were as follows: 1. Maximal heart rate was 189.5±4.69 beat/min in average which was 2.4 times as fast as those at resting state. Average maximal oxygen uptake and maximal energy cost were 51.4±5.69ml/kg/min, and 15.2±1.36kcal/kg/hr, respectively. These values were accounted for 14 times increase in both average oxygen uptake of 3.73±1.23ml/kg/min, and average energy cost of 1.08±0.38kcal/kg/hr at resting state. 2. During walking on level treadmill at speed of 2, 4, 6, and 8km/hr, respective average values of heart rate were 92.8±10.02, 98.1±11.46, 120.8±13.3, and 159.8±14.57 beat/min, of oxygen uptake 9.7±2.04, 13.4±2.53, 20.4±2.68 and 34.0±7.54ml/kg/min, and of energy cost 2.0±0.52, 3.9±0.70, 6.0±0.78 and 10.1±2.26 kacl/kg/hr. 3. Rates of increase in heart rate, oxygen uptake and energy cost were remarkable in comparison with the increase in speed of walking with less tan 15% grade of inclination, and the rate of increase was proportional to the increase in speed of walking with 15% grade of inclination. 4. Close association was observed between oxygen uptake(ml/min) and energy cost(kcal/hr) with coefficient of correlation r=0.9801(p<0.01). Linear regression of energy cost on oxygen uptake was expressed as Y=0.290 X+14.7 and standard deviation of the estimate was S_y/x=±51.9kcal/hr. This indicated that the energy cost per liter of oxygen consumed was equivalent to 5.08kacl/min of energy cost. 5. Linear regression of heart rate(beat/min) on oxygen uptake(X_1:ml.kg/min) and energy cost(X_2: kcal/kg/hr) were expressed as follows: Y=2.29X_1+77.9(S_y/x=±15.6beat/min) Y=7.84X_2+77.7(S_y/x=±15.4beat/min) with coefficient of correlation r=0.8884(p<0.01) for the former and r=0.8866(p<0.01) for the latter. 6. maximal aerobic work capacity of an individual could be assessed by the regression equation of heart rate(beat/min) on oxygen uptake(X: ml/min). Heart rate for persons with better maximal aerobic work capacity showed the slower heart rate with the same amount of oxygen uptake. It was suggested that in predicting the heart rate for the assessment of maximal work capacity, oxygen uptake during submaximal work should exceed at least 50% of the maximal value(3,500ml/min).

형질세포 골수종

윤치순(Yoon Chi Soon),김인(Kim In),문명상(Moon Myung Sang) 대한정형외과학회 1972 대한정형외과학회지 Vol.7 No.3

만성 폐전색증의 폐동맥 색전제거및 내막 절제술;치험 2례

이종국,윤치순,김은기,Lee, Jong-Guk,Yun, Chi-Sun,Kim, Eun-Gi 대한흉부심장혈관외과학회 1991 Journal of Chest Surgery (J Chest Surg) Vol.24 No.12

Two successful pulmonary thromboendartectomies were performed. In the first case, it was performed under cardiopulmonary bypass with moderate hypothermia and ventricular fibrillation In the second case, it was done under deep hypothermia and intermittent circulatory arrest. The patients are recovered uneventfully without complication and discharged from the hospital on warfarin. Their symptoms were improved and the follow-up pulmonary perfusion scans revealed no evidence of residual pulmonary embolus in both cases.

중심 정맥 port 삽입의 임상적 연구

김영진,윤치순,조현민,유영미 건양대학교 의과대학 2003 건양의대학술지 Vol.3 No.2

식도 재건 수술후 발생한 합병증 치험

이두연,윤치순,홍승록,Lee, Du-Yeon,Yun, Chi-Sun,Hong, Seung-Rok 대한흉부심장혈관외과학회 1991 Journal of Chest Surgery (J Chest Surg) Vol.24 No.5

Post-anastomotic leakage and stenoses remain major complications and are still responsible for many mortalities after esophageal reconstructive procedures. If the hand-suture is used, anastomotic leaks developed frequently than stenoses. But post-anastomotic leakages are more critical than post-anastomotic stenoses. If the stapler is used, anastomotic stenoses will develop frequently and not critical than anastomotic leakages. The stapler suture method is easier and quicker than the hand suture method in the esophageal anastomotic procedures. But the disadvantages of the stapler suture method is that there is not reachable site with anastomotic stapler the thoracic inlet region and the cost is expensive. We have treated 44 cases of the surgical complications after esophageal reconstructive procedure with conservative and surgical treatment for 10 years from January, 1980 to December, 1989. The anastomotic site stenoses were 8 cases in the hand-suture methods and 4 cases in the stapler-suture methods. The anastomotic leaks were 8 cases in hand-suture methods and 5 cases in stapler-suture methods. There were one death in the surgical repair of four post-operative anastomotic stenoses and two deaths in the surgical repair of three post-operative anastomotic leakages. Ever though we consider that there is more anastomotic leakage than stenoses after the hand-suture methods in esophageal reconstructive procedures. the cost with long stay in the intensive care unit to treat anastomotic leakage after the hand-suture, would be more expensive than-the cost of the treatment of the anastomotic stenoses after auto-suture.

신생아의 복잡심장기형에서 심장이식을 위한 동물실험

박영환,윤치순,정원석,김명옥,조범구 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.6

배경: 복잡심장기형의 경우 완전교정술식의 높은 난이도와 사망율로 말미암아 심장이식이 고려되고 있다. 그러나 정상심장을 이식하기에 곤란한 복잡기형의 경우 수술전 자세한 계획이 매우 중요하다고 하겠다. 신생아의 복잡심장기형에서 심장이식을 고안하기위한 동물실험을 하였다. 대상 및 방법: 8마리 신생돼지를 사용하여 4차례 심장이식실험을 하였다. 실험 1: 성인에서의 심장이식과 같은 방법으로 시행하였다. 실험 2: 좌심형성부전증후군(Hypoplastic Left Heart Syndrome)의 경우를 모의실험하기 위하여 공여돈의 대동맥궁을 이용한 성형수술을 하였다. 실험 3: 폐동맥성형술을 동반한 심장이식을 하였다. 실험 4: 이식후 장기 생존을 위한 실험을 시도하였다. 결과: 신생돈에서의 심장이식수술은 큰 어려움없이 시행할 수 있었다. 실험후 인공심폐순환에서 벗어날 수 있었으나 2마리는 폐동맥연결부위와 좌심방연결부위의 출혈로 사망하였다. 결론: 이상의 실험으로 대혈관의 위치에 따라 세심한 수술계획을 한다면 거의 실행하지 못할 복잡심장기형이 없을 것으로 보이며 신생아의 경우는 특히 출혈에 대해 주의를 해야 할 것으로 생각되었다. Background: Heart transplantation is considerated for a selected certain group of complicated congenital heart disease in neonates because corrective surgery is very difficult and has high mortality. Precise planning of transplantation is necessary to adequately fit the donor heart to the recipient. Material and Method: We have performed 4 neonatal pig heart transplantations to test the technical feasibility. Experiment 1: The transplantation was performed using the same technique as the adult heart transplantation. Experiment 2: The transplantation for hypoplastic left heart syndrome was simulated as we reconstructed the whole aortic arch with donor aorta. Experiment 3: The heart transplantation was done with radical pulmonary artery reconstruction. Experiment 4: The experiment was performed for a long term survival. Result: Preoperative planning was very important for adequate fitting. All animals could be weaned from cardiopulmonary bypass, however, two animals died due to bleeding at pulmonary artery and left atrium. Conclusion: We concluded that the neonatal heart transplantation can be applied in some complicated Further using animal model is mandatory.